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�I�r Town of Barnstable *Permit#
'e, p� Expires 6 months from issue date
EARNSTABLER : Regulatory Services Fee
rzAss Thomas F.Geiler,Director
'fD tAP` Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 ®P '
Office: .508-862-4038
Fax: 508-790-6230 MAY `- ' 2005
EXPRESS PERMIT APPLICATION - RESIDENTIAL,p&,LY_
Not Valid without Red X-Press Imprint r BARNS (A,.
Map/parcel Number
Property Address /21?"Oe
Residential Value of Work -300 O Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
- R
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
I am the Homeowner
❑ I have Worker's Compensation Insurance _
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
rRe-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
ET Replacement Windows. U-Value (maximum.44) ;
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ✓_
Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
i
Signature
Q:Forms:expmtrg
Revise063004
i En iacering=Dept.(3rd floor) Map '��� Parcel ��p �v `�Permit# � y�'7 j
% House# S-�' Date Issued
Board of Health(3rd floor)-(8:15 -9:30/1:00-4:30
Conservation Office(4th floor)(8:30-9:30/1:00-Z:00)
Rknuft=ft
and 19 SEPTIC ST BE
1NST L
TOWN OF BARNSTABLUNMONME ' C009 AND
Building Permit Application TOWN RIEGULATIONS
Project Street Address
Village
Owner X Address
Telephone 7
Permit Request
First Floor square feet Second Floor square feet
Construction Type
Estimated Project Cost $ Q,
Zoning District Flood Plain Water Protection
Lot Size Grandfathered ❑Yes 11 0
Dwelling Type: Single Family 31 Two Family ❑ Multi-Family(# its)
Age of Existing Structure �v 4,V,5 Historic House ❑Yes On Old King's Highway ❑Yes ,
Basement Type: u11 ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)
Number of Baths: Full: Existing�_ New Half. Existing New
No. of Bedrooms: Existing New
Total Room Count(not including bath : Existing New First Floor Room Count
Heat Type and Fuel: ❑Gas Oil ❑Electric ❑Other
Central Air es Fireplaces: Existing / New Existing wood/coal stove ❑Yes Rwo
Garage: Detached(size) Other Detached Structures: ❑Pool size
❑Attached(size) ❑Barn(size)
❑None ❑Shed(size) "
❑Other(size)
Zoning Board of Appeals;Athorization ElAppeal# Recorded❑Commercial ❑Yes p If yes, site plan review#
Current Use Proposed Use
Builder Information
Telephone Number 77,5
Addresss/ License#
Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATU ATE
BUILDING PERMIT DE I,E�pD FOEIE FOLLOWING REASO (S)
A •
r t FOR OFFICIAL USE ONLY '
PIERMIT NO.
DATE ISSUED
MAP/PARCEL NOS '' • `'
ADDRESS '; i VILLAGE
OWNER r 1 7. `� � r � �. � � _ - � •';.
DATE OF INSPECTION:
FOUNDATION
o-
$ ;
FRAME +a1.4 '
INSULATION
r
•FIREPLACE -
ELECTRICAL: ROUGH j FINAL •
PLUMBING: RQL H r FINAL
.
GAS: RQ FINAL "
FINAL BUI°LDING ' '
DATE CLOSED OUT:'`"
ASSOCIATION PLC `` -
e '
THE r,
The Town of Barnstable
. . . .
• ,�vs,.nsr.E. •
9 ' �e�' Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
For office use only
Permit no. '
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
` SUPPLEMENT TO PERMIT APPLICATION ,
MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization,
conversion, improvement, removal, demolition, or construction of an addition to any pre-existing
owner occupied building containing at least one but not more than four dwelling units or to
structures which are adjacent to such residence or building be done by registered contractors, with
certain exceptions,along with other requirements.
Type of Work: 2t'44 01 �s�� Est.Cos 010,
Address of Work: /?IS—
Owner's Name d�*� T �o✓a�� Cye.I r. Of/
Date of Permit Application: ///S / 7
I hereby certify that:
Registration is not required for the following reason(s):
Work excluded by law
Job under S1,000.
Building not owner-occupied
Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
G
Harp Ow is Name
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